Presentation and Outcomes of Pediatric Myocarditis in the Emergency Department: A Systematic Review and Meta-Analysis

Pediatric myocarditis, although rare, is associated with high morbidity and mortality, especially in emergency department (ED) settings where timely diagnosis and intervention are crucial. This systematic review and meta-analysis aim to consolidate current evidence regarding the clinical presentations, diagnostic findings, and outcomes of pediatric myocarditis in the ED, with an emphasis on the need for improved diagnostic and therapeutic strategies. A systematic search of PubMed, Scopus, Web of Science, EMBASE, and Medline was conducted through December 2023, identifying 17 studies that met strict inclusion criteria. Across 737 pediatric myocarditis cases, common clinical presentations included poor feeding (60.4%), fever (51%), respiratory distress (49.8%), and hypoperfusion (45.9%). Laboratory findings indicated elevated troponin in 80.4% of cases and increased C-reactive protein in 63.3%. Imaging and ECG data revealed cardiomegaly in 44.7% and ST/T wave abnormalities in 47.5%. Intensive Care Unit (ICU) admission was required for 88.1% of cases, with 46.9% needing mechanical ventilation, and an overall mortality rate of 15.7%. Pediatric myocarditis presents with non-specific symptoms, complicating early diagnosis in the ED. High rates of ICU admission and mortality highlight the urgency for rapid identification and timely intervention. Future research should aim to refine diagnostic markers and optimize treatment protocols to improve outcomes in this vulnerable population